What the USPSTF?! It’s time for some preventive medicine updates on: screening for unhealthy drug use, cervical cancer, hepatitis C and draft recs for colorectal cancer; plus how to interpret USPSTF screening recs. Dr. Amber-Nicole Bird @ABirdMD (Penn Medicine) refreshes our love for preventive medicine, with updates on the newest recommendations. She reviews how to appropriately interpret and adopt guidelines for our patients, being cognizant of the source. We shine light on the mechanism of USPSTF, including how their guidelines differ from others, so we can understand the value and context when utilizing the guidance in the clinic.
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Time Stamps*
*Note: Time Stamps refer to ad free version.
00:00 Intro, disclaimer, guest bio
02:40 Guest one-liner, Book recommendation, Favorite failure
07:35 USPSTF background
11:22 Level of certainty and grade
16:32 Screening for unhealthy drug use
26:32 Screening for hepatitis C
31:45 Cervical cancer screening
43:30 Choosing which guidelines to follow
49:06 Colorectal cancer screening draft
58:00 Non-evidence based screening
62:00 Take home points and Outro
Preventive Medicine Updates Pearls
Preventive medicine is complex and a powerful tool! Consider who generates the guidelines and the benefit:risk for your population
The USPSTF is a volunteer task force made up of experts in preventive medicine
Recommendations are for asymptomatic individuals and based on balancing harms and benefits; cost is not a consideration
The USPSTF recommendation for screening for unhealthy drug use has been updated. Verbally screen all adults for unhealthy drug use (not laboratory-based) if you can do something about a positive screen
The NIDA tool is a quick and effective tool for screening for unhealthy substance use
The USPSTF has updated their hepatitis C screening to include all adults ages 18-79 years; use a hepatitis C antibody test with reflex to RNA
The American Cancer Society has updated its guidelines for cervical cancer screening: (a) start screening at age 25 (b) primary HPV testing is the preferred test done every 5 years (c) stop screening after age 65 years (if prior 10 years normal screening or no CIN2 or higher in last 25 years)
At the time of these notes, there is a USPSTF draft recommendation for colorectal cancer screening that recommends lowering the age to start screening to 45 years
Preventive Screening Updates Notes
United States Preventive Services Task Force Background
Independent, volunteer task force made up of experts in preventive medicine
Volunteers from all areas of preventive medicine, including behavioral health, nursing, and gynecology
Tasked with studying prevention in a clinical context
Synthesize guidelines from existing research
Key points: Looking at asymptomatic individuals and looking at harms versus benefits
Cost is NOT a consideration when making recommendations
USPSTF will consider any public request for an update
Incidence of cervical cancer in women ages 21-24 is low
Accounts for less than one percent of patients with cervical cancer
Primary HPV testing every 5 years until the age of 65 years is preferred testing for all women undergoing cervical cancer screening
If not available, co-testing every 5 years or cytology only every 3 years (this is a transitional recommendation; will be removed from future guidelines)
Provides clear recommendations to stop screening after the age of 65 years
Requires adequate and normal screening for the 10 years prior
No CIN 2 or higher in past 25 years
Recommendation to phase out cytology probably based in part on impact of HPV vaccination
Incidence of cervical cancer is declining following routine HPV vaccination
Cytology less efficient in vaccinated populations
Disproportionately detects minor abnormalities associated with HPV types that are at lower risk of causing cancer
Colorectal Cancer Screening
USPSTF released draft recommendation for colorectal cancer screening in October of 2020
Part of a process to put up recommendations for public comments
Insurance may not cover screening recommendation changes until they are finalized
Draft recommendation recommends screening for colorectal cancer in adults aged 45 to 79 years (Grade B, moderate certainty) and adults aged 50 to 75 years (Grade A, high certainty)
Screening modalities can be stool-based (high-sensitivity guaiac-based FOBT, fecal immunochemical test, and stool DNA test) or direct visualization (colonoscopy, CT colonography, and flexible sigmoidoscopy).
USPSTF also recommends selectively offering colorectal cancer screening in adults aged 76 to 85 years (Grade C, moderate certainty)
Listeners will understand recent updates to preventive medicine guidelines and the rationale.
Learning objectives
After listening to this episode listeners will…
Understand the structure and role of the United States Preventive Service Task Force
Discuss the relevance and process of draft USPSTF recommendations
Screen for unhealthy drug use in a primary care population
Apply hepatitis C screening to adult patients
Compare and contrast the USPSTF and ACS screening guidelines for cervical cancer
Explain the changes to the new draft USPSTF recommendation for colorectal cancer screening
Disclosures
Dr. Bird reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Citation
Madnick D*, Wikoff P*, Bird A, Williams PN, Brigham SK, Watto MF. “#251 What the USPSTF? Preventive Medicine Updates with Dr Amber Nicole Bird”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date January 18, 2021.
CME Partner
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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